title: Bullae and sweat gland necrosis in the differential diagnosis for Vibrio vulnificus infection in an alcoholic patient.
abstract: Bullae and sweat gland necrosis remain rare cutaneous manifestation, and these conditions can be misdiagnosed as Vibrio vulnificus infections or other soft tissue infections because of their low index of suspicion. A 46-yr-old man with a history of continued alcohol consumption presented with erythematous and hemorrhagic bullous lesions on his left arm. The patient reported that after the ingestion of clams, he slept for 12 hr in a heavily intoxicated state. Then the skin lesions started as a reddish patch that subsequently became hemorrhagic bullae. V. vulnificus infection, cellulitis, and necrotizing fasciitis were considered in initial differential diagnosis. However, on the basis of sweat gland necrosis on histopathologic examinations and negative results on bacterial cultures, we made the diagnosis of bullae and sweat gland necrosis. Therefore, bullae and sweat gland necrosis should also be considered in chronic alcoholic patients who present with bullae and a previous history of unconsciousness.
authors.affiliation: Department of Dermatology, School of Medicine, Pusan National University, 179 Gudeok-ro, Busan, Korea.
authors.forename: Gun-Wook
authors.initials: GW
authors.lastname: Kim
authors.forename: Hyun-Je
authors.initials: HJ
authors.lastname: Park
authors.forename: Hoon-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Su-Han
authors.initials: SH
authors.lastname: Kim
authors.forename: Hyun-Chang
authors.initials: HC
authors.lastname: Ko
authors.forename: Moon-Bum
authors.initials: MB
authors.lastname: Kim
authors.forename: Byung-Soo
authors.initials: BS
authors.lastname: Kim
mesh_terms: D000435:Alcoholic Intoxication / Q000209:etiology; D000437:Alcoholism / Q000175:diagnosis; D001768:Blister / Q000150:complications / Q000175:diagnosis*; D002481:Cellulitis / Q000175:diagnosis; D003937:Diagnosis, Differential; D019115:Fasciitis, Necrotizing / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000150:complications / Q000175:diagnosis; D013543:Sweat Gland Diseases / Q000150:complications / Q000175:diagnosis*; D014735:Vibrio Infections / Q000175:diagnosis